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# Provider Network, Credentialing and Provider Disputes Manager

- **Company:** Health Plans, Inc.
- **Location:** United States
- **Experience:** Experienced
- **Salary:** $84,510.0 - $126,651.0
- **Contract:** Permanent contract
- **Skills:** Data Analysis, Graphics Software, Microsoft Office, Microsoft Software, Network Administration, Data Management
- **Published:** May 23, 2026
- **Apply:** https://www.indeed.com/viewjob?jk=65b55c840b4065e8

## About the Role

Do you have experience in Team leadership?, Do you have a Master's degree?, * Bachelor degree or equivalent in Business Administration, Health Care or related field.

 * Master degree or equivalent in Business Administration, Health Care or related field preferred
 * Three years' prior experience in market analysis, product development, business development or provider contracting in a health plan setting preferred.
 * Must be able to explain health care financing and its relation to third party provider contractual arrangements.
 * Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies; ability to develop and deliver presentations.
 * Excellent time management, organizing and coordinating skills.
 * Strong history of achieving personal and corporate goals and objectives.
 * Must demonstrate professionalism, good judgment, and tact when dealing with sensitive and confidential issues.
 * Strong skills in Microsoft applications including MS Office; graphic software experience preferred.

Physical Requirements

 * Able to lift up to 30 pounds
 * Use proper body mechanics when handling equipment
 * Standing, walking and moving 50% of the day

## Description

The Manager, Provider Network manages the development of the provider networks to meet the strategic goals for all of CCHP's product lines. The position maintains the integrity of the managed care or potentially other downstream payer contracts to satisfy CCHP's strategic quality and regulatory objectives. The position will evaluate and maintain direct or downstream relationships with providers to be in regulatory compliance, within reimbursement structure standards and conforming to other key process controls. Additional routine activities include provider data management and managing the day-to-day activities of the Network Management department and staff., * Ensures the provider network meets the health care needs of CCHP members.

 * Oversees training, orientation and coaching for performance improvement within physician practices.
 * Acts as a liaison with the provider community to maintain and/or improve relationships between providers and health plan.
 * Ensures timely health plan updates to network providers.
 * Manages provider performance and supports the development and implementation of value-based contract relationships in support of business strategies.
 * Ensures timely resolution of escalated provider issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.
 * Conducts audits of network adequacy for each service area in order to maintain member access at desired levels.
 * Works collaboratively with and makes recommendations to Contracting to enhance CCHP's provider network.
 * Monitors provider network contracts to ensure compliance with financial and operational terms.
 * Manages CCHP provider directories and ensures that they are accurate and up-to-date.
 * Develops and updates policies and procedures related to provider network to comply with external regulators and internal business requirements.
 * Performs on-going analysis of data and information looking for opportunities for continuous improvement in health plan operations and in provider relations.
 * Manages and oversees all credentialing of new providers (including facilities)
 * Manages and oversees the recredentialing of providers
 * Ensures that all providers credentialed by delegates are included in the provider directory.
 * Works with providers and internal stakeholders to manage and oversee provider disputes and resolution
 * Manages Provider Disputes to ensure that disputes are managed in accordance with the regulations
 * Accepts and performs other duties as assigned.

CORE COMPETENCIES

 * Must possess and consistently demonstrate the following competencies:
 * Management - Makes the best use of available time and resources. Acknowledges and corrects mistakes. Shows up to work on time, and follows instructions, policies, and procedures. Meets productivity standards, deadlines, and work schedules. Prioritizes tasks by importance and deadline. Displays an ongoing commitment to learning and self-improvement. Desiring and making an effort to acquire new knowledge or skills for work.
 * Leadership Effectiveness - Leads by example and sets standards for professional behavior. Helps those in need of assistance, regardless of rank. Offers help when needed. Identifies what needs to be done and takes action before being asked or required. Recognizes situations that warrant initiative and moves forward without hesitation. Displays a positive attitude about the work to be done, co-workers, customers, management, and policies. Conveys positive attitude in the process of change.
 * Decision Making and Judgment - Coordinates ideas and resources to achieve goals. Identifies, collects, and organizes data for analysis and decision-making. Shows insight into the root-causes of problems. Generates a range of solutions and courses of action with benefits, costs, and risks associated with each. Examines data to grasp issues, draw conclusions, and solve problems.
 * Teamwork - Conveying confidence in co-workers' ability to be successful, especially with new and challenging tasks. Earns others' trust and respect through consistent honesty and professionalism in all interactions. Builds constructive working relationships characterized by a high level of acceptance, cooperation, and mutual respect. Maintains an open, approachable manner, and treats others fairly and respectfully. Preserves others' self-confidence and dignity, and shows regard for their opinions. Promotes cooperation and commitment within a team to achieve goals and deliverables.
 * Continuous Improvement - Adapting to and working with a variety of situations, individuals, and groups. Demonstrates openness to new organizational structures, procedures, and technology. Openness to different and new ways of doing things. Willingness to modify one's way of doing things. Diligently attends to details and pursues quality in accomplishing tasks. Develops fresh ideas that provide solutions to all types of workplace challenges.
 * Communication - Keeps manager informed about progress and problems. Ensures that others involved in a project or effort are kept informed and developments and plans. Allows others to speak without unnecessarily interrupting them. Gives the speaker undivided attention and appears interested in the message (e.g., maintains eye contact, nods). Gets along and interacts positively with co-workers and others. Asks and answers questions that enhance the clarity, quality, and reliability of information.
 * Work Product Quality - Adheres to all workplace and trade safety laws, regulations, standards, and practices. Displays openness to different or new ways of doing things and sees multiple perspectives. Responds positively to change, embracing and using new practices or values to accomplish goals and solve problems. Respects and maintains confidentiality. Tells the truth and is honest in all dealings. Encourages and supports others at work. Focuses on results and desired outcomes and how best to achieve them in order to get the job done. Willingly puts in extra time and effort in crisis situations; goes the "extra mile" to ensure the goal is met. Defining tasks and milestones to achieve objectives, while ensuring the optimal use of resources to achieve those objectives.
 * Customer Service - Builds and maintains customer satisfaction with the products and services offered by CCHP. Meeting and exceeding customer needs while cultivating relationships that secure commitment and trust. Seeks customer feedback and ensures needs have been fully met. Be positive when interacting with customers. Delivers products and services when and where the customer needs them. Engages customer in identifying issues, options, and desired outcomes. Develops a clear picture of the needs and best options from the client/customers' perspective. Remains committed to helping the client long after initial solutions have been applied. Follows up to make sure desired outcomes are realized. Acts proactively, recognizing important trends that will affect customers. Communicates those trends so clients can better prepare to meet new challenges. Develops new services and service models in line with those needs. Anticipates and recognizes the concerns of others, even if
those concerns are not openly expressed. Provides excellent services to internal and external customers.


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